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FOR OFFICE U _ <br /> /f � Z---z ~--- APPLICATION FOR SANITATION PERMIT�-4-3 - Permit No. .. . <br /> -- (Complete in Duplicate) <br /> Date Issued ___ <br /> --------------------------- This Permit Ex fres 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATI N____. -Z��... � <br /> -------------- <br /> -----------------•-------...------•-----------.......------------------------------------ <br /> Owner's Name...-/l.N!�?.--- ----- Phone------------------------------------ <br /> Address........ <br /> ------------------•--------Address--••••.. -------------------- ------------_-------------- -------- -----•--------------------------------_-.-------------------••-•--•--_--------•---------------- <br /> Contractor's Name-------- -o--•-V•-•T�---------•----------------• .- .... Phone..----------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----I__ Number of bedrooms Number of baths ..../-- Lot size ....... _______________________________ <br /> Water Supply: Public system [R---Community system ❑ Private ❑ Depth ro Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®---Hardpan ❑ <br /> Previous Application Made: (if yes,date__.-.---------------) No 2�New Construction: Yes 2�0Vo ❑ FHA/VA: Yes ❑ No R <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi anlF: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- <br /> 1 No. of compartments--------------------------Size----._..------------------------Liquid depth--------------------------Capacity....................... <br /> I <br /> DisposalFi Distance from nearest well.___�'---------Distance from foundation.../A-__________Distance to nearest lot IineS.......... <br /> ❑ Number of lines---------_I- --------------------Length of each line----�O-(---------------Width of french----S'__'--___-._______------ <br /> ��f` Type of filter material._!.P.CA-__________-Depth of filter material_Id:__'______-.-._Total length____.7o_______________________________ <br /> Seepage Pit: Distance to nearest well__"^,__-______Distance from foundation___!!------------Distance to nearest lot line__'1.. _------- <br /> UK Number of pits------ -____--Lining matenal�b�.../�-.---Size: Diameter-33 •01 <br /> -------- ---Depth----- -•-------_-.... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- - <br /> ❑ Size: Diameter--------------------------------------Depth-------•------------------- ------------------------Liquid Capacity----------------------------gala. �. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building______-.__.________-________________--. [� <br /> ❑ Distance to nearest lot line------------------------------------------------ •---•------------------•-------------•------------------------------------------------------- 'r <br /> fi <br /> Remodeling and/or repairing (describe):--------- --------------------------------••------•-----------------------------------•-•--------------------------------------••-------•---------------- <br /> ----------------------------------------------------•-•---------------•--•----.----------•------------------------------------------•---•-•-------------------------- -------------­----------­----. -------------- <br /> P_ <br /> - --------------------- <br /> ------- ---- <br /> - ---...__.-••-------- -----------------------------------------------•------------------------------------------------- ------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> `ordinances, State laws, and rules and regulations of the an Jo quin Local Health District. <br /> (Signed)--------------------------------------------- ------------------------------ --------- ----------- -----•----------------------------------------------(Owner and/or Contractor) <br /> BY� {Title) <br /> -------------- ---------- --------- --------- ---- --------------------------- <br /> (Plot plan, showing size of lot, location of sys em in relation to we , buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- --- ---------- - '�� ---------------- DATE------ ---------'f~ h <br /> REVIEWED BY-------------------------------- - ---------- ---------------------------------- ----------------------------- DATE.--.----•----------------••-------- <br /> ----------------------- <br /> BUILDING PERMIT ISSUED-----..---•-•-------_------------------------------------------------------------ ----------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations----------------------------------------------------......... ----------------------•---------------••-•-------------------------------------------------------- <br /> -----•---------------------------------------------------------•--•-------------------------------------------------------------------- ----------•-•-- --------------------------••-•---------------------------------------- <br /> -------------------------------------- -------------------------------------------------------------------••-------------------------------._...---------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.--- ` ------------- Date------ ------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wert Oak Street 124 Sycamore Street 205 Wort 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />